Cushingʼs Syndrome in Pregnancy

Pickard, Jeffrey; Jochen, Albert; Sadur, CRAlG N.; Hofeldt, Fred D.

doi:10.1097/00006254-199002000-00002

Cited by 62 publications

(33 citation statements)

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“…In humans, stillbirth is frequently associated with maternal hypertension or diabetes (3,6,21,32) but is also increased in women with Cushing's disease (17,26,34,35) and maternal stress or depression (8,10,16,37), in which maternal cortisol would be chronically increased. Our study suggests that the adverse outcomes in ovine pregnancy with hypercortisolemia may be related to the metabolic effects of cortisol in the mother and/or fetus.…”

Section: Perspectives and Significancementioning

confidence: 99%

“…Either increased or decreased maternal cortisol concentrations slowed the rate of fetal growth between 115 and 130 days of gestation. In women with Cushing's disease or Cushing's syndrome in pregnancy, there is also an increased incidence of small-for-gestational-age babies, as well as an increased risk of adverse pregnancy outcomes (26,34). Maternal glucocorticoid treatment with dexamethasone or betamethasone is also known to reduce fetal growth and alter glucose in the offspring of sheep and rats (22,23,25).…”

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Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy

Keller‐Wood

Feng

Wood

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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Keller-Wood M, Feng X, Wood CE, Richards E, Anthony RV, Dahl GE, Tao S. Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy. Am J Physiol Regul Integr Comp Physiol 307: R405-R413, 2014. First published June 11, 2014 doi:10.1152/ajpregu.00530.2013.-In normal pregnancy, cortisol increases; however, further pathological increases in cortisol are associated with maternal and fetal morbidities. These experiments were designed to test the hypothesis that increased maternal cortisol would increase maternal glucose concentrations, suppress fetal growth, and impair neonatal glucose homeostasis. Ewes were infused with cortisol (1 mg·kg Ϫ1 ·day Ϫ1 ) from day 115 of gestation to term; maternal glucose, insulin, ovine placental lactogen, estrone, progesterone, nonesterified free fatty acids (NEFA), ␤-hydroxybutyrate (BHB), and electrolytes were measured. Infusion of cortisol increased maternal glucose concentration and slowed the glucose disappearance after injection of glucose; maternal infusion of cortisol also increased the incidence of fetal death at or near parturition. The design of the study was altered to terminate the study prior to delivery, and post hoc analysis of the data was performed to test the hypothesis that maternal metabolic factors predict the fetal outcome. In cortisol-infused ewes that had stillborn lambs, plasma insulin was increased relative to control ewes or cortisol-infused ewes with live lambs. Maternal cortisol infusion did not alter maternal food intake or plasma NEFA, BHB, estrone, progesterone or placental lactogen concentrations, and it did not alter fetal body weight, ponderal index, or fetal organ weights. Our study suggests that the adverse effect of elevated maternal cortisol on pregnancy outcome may be related to the effects of cortisol on maternal glucose homeostasis, and that chronic maternal stress or adrenal hypersecretion of cortisol may create fetal pathophysiology paralleling some aspects of maternal gestational diabetes. glucose; insulin; cortisol; pregnancy MATERNAL CORTISOL IS INCREASED in normal human pregnancy and is thought to contribute to the increase in maternal glucose concentration, as well as supporting increases in maternal plasma volume and cardiac output. In studies done in our laboratory, we have found that increasing maternal cortisol beyond the normal doubling in ovine pregnancy led to increased uterine blood flow and maternal and fetal glucose and lactate concentrations, whereas decreasing maternal cortisol to concentrations similar to those of nonpregnant ewes resulted in reduced uterine blood flow as gestation advanced (12, 13). Either increased or decreased maternal cortisol concentrations slowed the rate of fetal growth between 115 and 130 days of gestation. In women with Cushing's disease or Cushing's syndrome in pregnancy, there is also an increased incidence of small-for-gestational-age babies, as well as an increased risk of adverse pregnancy outcomes (26, 34). Maternal glucocorticoid treatme...

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Section: Perspectives and Significancementioning

confidence: 99%

mentioning

confidence: 99%

Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy

Keller‐Wood

Feng

Wood

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Sólo 40% de los embarazos llegan a término en pacientes portadoras de síndrome de Cushing. El 35% termina prematuramente y 20% termina en aborto [6][7][8][9][10] .…”

Section: Discussionunclassified

“…Por otro lado, 61% de las embarazadas con hipercortisolismo desarrolla diabetes gestacional, 87% desarrolla hipertensión arterial, y la incidencia de complicaciones como preeclampsia, edema pulmonar, infección postparto, cesárea y anormalidades en la coagulación, está incrementada 9,10 .…”

Section: Discussionunclassified

Cirugía transesfenoidal en enfermedad de Cushing durante gestación: Report of one case

Verdugo¹,

Alegría²,

Grant³

et al. 2004

Rev. méd. Chile

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(Rev Méd Chile 2004; 132: 75-80La causa más frecuente de síndrome de Cushing en pacientes embarazadas es un adenoma suprarrenal 2,3 . La causa hipofisiaria es infrecuente, al contrario de lo que ocurre en no gestantes. En la literatura se han publicado alrededor de 10 pacientes con enfermedad de Cushing durante el embarazo.La paciente que se presenta corresponde al quinto caso tratado durante la gestación mediante adenomectomía transesfenoidal. CASO CLÍNICOPaciente de 26 años de edad, quien presentó progresivamente, en un lapso de 9 meses antes de la consulta, cuadro caracterizado por aumento de peso de 20 kilos, aumento de volumen facial e

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“…Her morning and evening plasma cortisol levels were 26.3 g/dL (normal: 5-25 g/dL) and 34. 6 g/dL (normal: half of the morning level), respectively. 24 hr urinary free cortisol were 409.5 nmol/day (normal: 55-248 nmol/day), and were not suppressed with low-dose or Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma

Kim¹,

Lee²,

Je³

et al. 2003

J Korean Med Sci

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Cushing s syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing s syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing s syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.

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Cushingʼs Syndrome in Pregnancy

Cited by 62 publications

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Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy

Elevated maternal cortisol leads to relative maternal hyperglycemia and increased stillbirth in ovine pregnancy

Cirugía transesfenoidal en enfermedad de Cushing durante gestación: Report of one case

A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma

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